AMINOGLYCOSIDE DOSING - ONE, 2 OR 3 TIMES A DAY

The safety and efficacy of conventional aminoglycoside dosing regimens have been proven in clinical trials. Higher doses at longer intervals may be more effective if they result in higher peak serum levels of t he drug, but few trials of ''once-a-day'' dosing have shown improved c linical as outcome. The clinical safety of allowing trough serum level s to fall below the minimum inhibitory concentration is not establishe d Literal ''once-a-day'' dosing will result in drug accumulation and t oxicity in patients with reduced renal clearance, and in potential lac k of efficacy and the emergence of antibiotic-resistant organisms in t hose with increased renal clearance. However, modified ''once-a-day'' dosing, with the interval determined by the individual's renal clearan ce rate (hence avoiding subtherapeutic trough levels), will avoid thes e problems.